Comparing the Efficacy of OnabotulinumtoxinA, Sacral Neuromodulation, and Peripheral Tibial Nerve Stimulation as Third Line Treatment for the Management of Overactive Bladder Symptoms in Adults: Systematic Review and Network Meta-Analysis.

The American Urological Association guidelines for the management of non-neurogenic overactive bladder (OAB) recommend the use of OnabotulinumtoxinA, sacral neuromodulation (SNM), and peripheral tibial nerve stimulation (PTNS) as third line treatment options with no treatment hierarchy. The current study used network meta-analysis to compare the efficacy of these three modalities for managing adult OAB syndrome. We performed systematic literature searches of several databases from January 1995 to September 2019 with language restricted to English. All randomized control trials that compared any dose of OnabotulinumtoxinA, SNM, and PTNS with each other or a placebo for the management of adult OAB were included in the study. Overall, 17 randomized control trials, with a follow up of 3-6 months in the predominance of trials (range 1.5-24 months), were included for analysis. For each trial outcome, the results were reported as an average number of episodes of the outcome at baseline. Compared with the placebo, all three treatments were more efficacious for the selected outcome parameters. OnabotulinumtoxinA resulted in a higher number of complications, including urinary tract infection and urine retention. Compared with OnabotulinumtoxinA and PTNS, SNM resulted in the greatest reduction in urinary incontinence episodes and voiding frequency. However, comparison of their long-term efficacy was lacking. Further studies on the long-term effectiveness of the three treatment options, with standardized questionnaires and parameters are warranted.

The efficacy of acupuncture in managing patients with chronic prostatitis/chronic pelvic pain syndrome: A systemic review and meta-analysis.

OBJECTIVES: This study aimed to systemically review published randomized control trials that compared the efficacy of acupuncture with sham acupuncture or standard medical treatment as management for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: A systemic search of the PubMED®, Embase, Airiti Library, and China Journal Net was done for all randomized controlled trials that compared the efficacy of acupuncture with sham acupuncture, alpha-blockers, antibiotics, or anti-inflammatory drugs in patients with CP/CPPS. Two investigators conducted the literature search, quality assessment, and data extraction. The data were then analyzed using the Cochrane Collaboration Review Manager (RevMan®, version 5.3). The study endpoints were response rate, the National Institute of Health-Chronic Prostatitis Index (NIH-CPSI), and the International Prostate symptom score (IPSS) reduction. RESULTS: Three and four randomized controlled trials compared acupuncture with sham acupuncture (n = 101 vs. 103) and medical treatment (n = 156 vs. 138), respectively. The results revealed that acupuncture was superior to sham acupuncture as regards response rate (OR: 5.15, 95%CI: 2.72-9.75; P < 0.01), NIH-CPSI (WMD: -6.09, 95%CI: -7.85 to -4.33), and IPSS (WMD: -2.44, 95%CI: -4.86 to -0.03; P = 0.05) reductions, therefore, excluding the placebo effect. Compared to standard medical treatments, acupuncture had a significantly higher response rate (OR: 3.57, 95%CI: 1.78-7.15; P < 0.01). CONCLUSIONS: Acupuncture has promising efficacy for patients with CP/CPPS. Compared to standard medical treatment, it has better efficacy. Thus, it may also serve as a standard treatment option when available. Neurourol. Urodynam. 36:474-481, 2017. © 2016 Wiley Periodicals, Inc.

Prostate volume did not affect voiding function improvements in diode laser enucleation of the prostate.

PURPOSE: We compared safety and surgical outcomes in patients with different prostate sizes treated with diode laser enucleation of the prostate. MATERIALS AND METHODS: From 2008 to 2012 consecutive patients with benign prostatic obstruction undergoing diode laser prostate enucleation at our institution were enrolled for analysis. A single surgeon performed diode laser prostate enucleation with an end firing, continuous wave diode laser (980 nm). Based on preoperative prostate volume on transrectal ultrasound, patients were stratified into 2 groups, including group 1-65 with less than 60 ml and group 2-55 with 60 ml or greater. Baseline and perioperative characteristics, and postoperative surgical outcomes were compared between the 2 groups. RESULTS: A total of 120 men with a mean ± SD age of 70.2 ± 9.0 years were enrolled for analysis. Compared with group 1 patients, those in group 2 had larger mean total prostate volume (85.0 ± 24.6 vs 40.9 ± 10.8 ml), longer mean operative time (117.7 ± 48.2 vs 60.7 ± 25.0 minutes), higher mean retrieved prostate weight (37.3 ± 16.1 vs 12.5 ± 7.3 gm) and a higher mean tissue retrieval ratio (74.4% ± 22.2% vs 58.8% ± 23.2%, p <0.01). There was no significant difference in the postoperative hemoglobin decrease in the 2 groups (median 0.5 vs 0.9 mg/dl, p = 0.11). The rate of temporary postoperative urinary retention after Foley catheter removal was significantly lower in group 2 (15.4% vs 3.6%, p = 0.04). Postoperative improvements in the peak flow rate, post-void residual urine volume and International Prostate Symptom Score were comparable in the 2 groups. CONCLUSIONS: Although patients with a larger prostate required significantly longer operative time and laser energy, voiding function improvements and surgical complication rates of diode laser prostate enucleation were comparable in patients with a larger vs smaller prostate.

Advances in non-surgical treatments for urinary tract infections in children.

OBJECTIVE: With growing antibiotics failure due to emerging resistance of bacteria, non-surgical management of pediatric UTI plays a more important role because of its non-invasive characteristics and little adverse effects. METHODS: We searched the Pubmed for management of UTI in children other than surgical correction and antibiotics using terms: risk factor, prepuce/phimosis, steroid cream/steroid, behavioral therapy, urotherapy, biofeedback/pelvic floor exercise, adrenergic antagonist, anticholinergics, diet/dietary, dysfunctional voiding/dysfunctional elimination syndrome, constipation, dietary, clean intermittent catheterization, probiotics/lactobacillus, cranberry, vitamin supplement, breastfeeding, breast milk, with infant/child/children/pediatrics/pediatrics and urinary tract infection. RESULTS: The proposed non-surgical management of pediatric UTI included behavioral modification (timed voiding and adequate fluids intake), topical steroid for phimosis, nutrient supplements (breast milk, cranberry, probiotics, and vitamin A), biofeedback training for dysfunctional voiding, anticholinergics for reducing intravesical pressure, alpha-blockers in dysfunctional voiding and neurogenic bladder, and intermittent catheterization for children with large PVR. CONCLUSION: The published reports usually included small number of patients and were lacking of randomization and controlled group. Further well-designed studies are warranted to support the concepts of non-operative management for pediatric UTI.

Minilaparoscopic herniorrhaphy in pediatric inguinal hernia: a durable alternative treatment tostandard herniotomy.

BACKGROUND: The purpose of the article is to report our long-term results of minilaparoscopic inguinal hernia repair in children. METHODS: Between September 2003 and September 2008, 161 children with inguinal hernia were treated with minilaparoscopic herniorrhaphy. The asymptomatic contralateral internal ring was routinely explored and repaired if a patent processus vaginalis of not less than 2 cm was noted. Patients who were followed for less than 1 year and those who were lost to follow-up were excluded from the study. Intraoperative and postoperative complications and hernia recurrences were documented. RESULTS: In total, 146 patients were eligible for final analysis. A total of 196 minilaparoscopic herniorrhaphies were performed. The mean follow-up period was 3 years. There were 4 hernia recurrences (2%) in 3 boys. There were no procedure-related complications. None of the patients with a negative contralateral exploration or a contralateral patent processus vaginalis of less than 2 cm had a contralateral metachronous inguinal hernia. CONCLUSIONS: Our long-term results reveal that minilaparoscopic herniorrhaphy combined with hernia sac transection is a safe and effective alternative treatment to standard open herniotomy.